Under 42 CFR § 409.61, Original Medicare Part A covers up to 100 skilled nursing facility days per benefit period: days 1–20 cost you nothing for covered services, and for days 21–100 you owe a daily coinsurance that CMS set at $217.00 for 2026.
By the VerifyDoc team
This guide gives you a checklist for reading a skilled nursing facility (SNF) bill against those day-count limits, then walks through how the 100 days are counted, what makes a hospital stay qualify, when a benefit period resets, and what to do when the facility says Medicare coverage is ending. An illustrative worked example shows the math line by line.
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Check my bill — free preview →What should I check first on a skilled nursing facility bill?
Check the day count first, because almost every dollar on an SNF bill under Original Medicare depends on which day of the benefit period each charge falls on. A bill that starts charging coinsurance too early, or treats you as having no days left when you do, can be off by thousands of dollars.
- Your qualifying hospital stay. Confirm you were an inpatient for at least 3 consecutive calendar days, not counting the discharge day.
- The admission gap. Confirm you entered the SNF within 30 calendar days of leaving the hospital.
- Which benefit period you're in. Find out whether this stay started a new benefit period or continued an earlier one, and how many SNF days you'd already used in it.
- Where coinsurance starts. Coinsurance should begin on the 21st covered day of the benefit period, not the 21st day of this particular stay if you used SNF days earlier in the same period.
- The daily rate. For 2026, the Part A SNF coinsurance is $217.00 per day for days 21–100, according to CMS.
- Day 101 and beyond. After 100 days in a benefit period, Part A pays nothing more for SNF care, so check that any full-price days really are past day 100.
- Your Medicare Summary Notice. Match the facility's bill to what Medicare says it processed. A day Medicare covered shouldn't show up as fully patient-owed.
Ask the facility for an itemized statement that lists each date of service. The same line-by-line approach in our guide on how to read an itemized hospital bill works here, and it's the fastest way to spot charges for days or services you didn't receive.
How does Medicare count the 100 SNF days in 2026?
The 100 days belong to the benefit period, not to a single stay. Under 42 CFR § 409.61, Medicare covers up to 100 days of posthospital SNF care in each benefit period; for the 21st through 100th day, Medicare pays for all covered services except a daily coinsurance amount.
That's why the count matters so much. If you spent 15 days in an SNF in March, went home, and were readmitted in April within the same benefit period, your April stay starts at day 16, not day 1. Coinsurance would kick in after just 5 more days.
| Days in the benefit period | What Original Medicare pays | What you pay (2026) |
|---|---|---|
| Days 1–20 | All covered services | $0 for covered services |
| Days 21–100 | All covered services except coinsurance | $217.00 per day |
| Day 101 and after | Nothing for SNF care | All costs |
Here's an illustrative example, not a real patient's bill. Say you're admitted to an SNF after a qualifying hospital stay, it's the start of a new benefit period, and you stay 30 covered days. Days 1–20 cost $0. Days 21–30 are 10 days at $217.00, so your coinsurance should be $2,170.00. If the bill shows 15 coinsurance days, or a rate other than $217.00 for 2026 dates of service, ask the facility to show its count.
Did my hospital stay actually qualify me for SNF coverage?
Only if you were hospitalized as an inpatient for at least 3 consecutive calendar days, not counting the date of discharge, under 42 CFR § 409.30. The same section generally requires that the SNF care start within 30 calendar days after the date you were discharged from the hospital.
The discharge-day rule trips people up. Admitted Monday and discharged Thursday counts Monday, Tuesday, and Wednesday: three days. Admitted Monday and discharged Wednesday is only two. The other common problem is status. Time a hospital billed as outpatient observation isn't inpatient time, even if you stayed overnight in a hospital bed. Our post on observation versus inpatient admission explains how to check which status you were in.
If your stay didn't qualify, Original Medicare won't cover the SNF stay, and the bill may be correct even though it's large. If you think it did qualify, ask the hospital for your admission order and discharge date, and ask the SNF which hospital dates it used.
When does a benefit period reset, and when does it not?
A benefit period ends once you've gone at least 60 consecutive days without being an inpatient in a hospital or getting skilled care in a SNF, under 42 CFR § 409.60. Only after that does a new benefit period, with a fresh 100 SNF days, begin.
A new benefit period isn't free. It also brings a new Part A inpatient hospital deductible, which CMS set at $1,736 for 2026. That deductible belongs to the hospital stay that starts the new benefit period, not to the SNF bill: you don't pay it for SNF care if you already paid it for a hospital stay in the same benefit period. So a hospital bill can be right to charge it again, but only if the 60-day gap really happened, and an SNF bill that charges it is usually wrong.
A short break works the other way. Medicare says that if your break in SNF care lasts less than 30 days, you don't need a new 3-day inpatient hospital stay to get more SNF care covered, but you're still in the same benefit period and can use only the SNF days you have left. A facility that restarts your count at day 1 after a short break is likely billing Medicare wrong. Coinsurance from day 1 of the new stay is correct only if you'd already used 20 or more SNF days in this benefit period; if you hadn't, ask how the facility counted.
What can I do if the facility says Medicare coverage is ending?
Ask for a fast appeal. Before Medicare-covered SNF services end, the facility should give you a Notice of Medicare Non-Coverage. Medicare says the notice should arrive at least 2 days before covered services end, and that you should call your BFCC-QIO, an independent reviewer, no later than noon of the day before the termination date on that notice. A later request can still be reviewed, but you may lose the protection from paying for the days in between (42 CFR § 405.1202).
Act fast, because the deadline on the notice is short and it's printed on the notice itself. Keep a copy of the notice and write down the date and time you called. If the facility later bills you for days after coverage ended, the notice and your appeal record are what you'll check those charges against.
Medicare Advantage plans work differently. They set their own SNF cost-sharing, so the $217.00 figure may not apply. If your plan is ending your SNF coverage, you get the same kind of notice (a Notice of Medicare Non-Coverage) and the same fast-track appeal to the BFCC-QIO, with the same noon-the-day-before deadline (42 CFR §§ 422.624 and 422.626) — use that, not the slower route below, while you're still in the facility. For other coverage denials, the decision is an organization determination. If your plan denies it, you have 60 calendar days after you receive the written notice to request a standard reconsideration, under 42 CFR § 422.582(b), and the plan must decide, or send an adverse decision to an independent reviewer, within 30 calendar days of receiving the request, under 42 CFR § 422.590(a), though it can take an extension in some cases.
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Check my bill — free preview →Frequently asked questions
Does Medicare cover all 100 SNF days automatically?
No. The 100 days are a maximum per benefit period under 42 CFR § 409.61, not a guarantee. You need a qualifying inpatient hospital stay of at least 3 consecutive calendar days, not counting the discharge day, and you must need skilled care that Medicare covers. If you stop needing skilled care, coverage can end well before day 100.
Why am I being charged coinsurance on my first week in the nursing facility?
Usually because you'd already used SNF days earlier in the same benefit period. Coinsurance starts on the 21st covered day of the benefit period, not the 21st day of each stay. Ask the facility which earlier stay it counted, and compare that with your Medicare Summary Notices. If you had no earlier SNF days in this benefit period, the coinsurance is likely an error.
How much is the SNF coinsurance in 2026?
According to CMS, the Original Medicare Part A SNF coinsurance is $217.00 per day for days 21 through 100 of a benefit period in 2026. Days 1 through 20 cost $0 for covered services. After day 100, Part A pays nothing for SNF care in that benefit period. Medicare Advantage plans set their own cost-sharing, so check your plan's documents.
If I go back to the hospital, do I get a new 100 days?
Not unless a new benefit period has started. Under 42 CFR § 409.60, a benefit period ends only after you've gone at least 60 consecutive days without being an inpatient in a hospital or getting skilled care in a SNF. A readmission before then continues the same benefit period and the same SNF day count. When a new benefit period does start, the Part A deductible ($1,736 in 2026) applies again to the hospital stay that starts it.